Tumor that often invades the Renal Vein and may extend into the Vena Cava and Right Atrium

Renal Cell Carcinoma

What is the most common mode of spread of Renal Cell Carcinoma?

Renal vein invasion

What does Renal Cell Carcinoma arise from?

Tubular Epithelium

What are the common hematogenous sites of spreading of Renal Cell Carcinoma?

Lungs

Bone

Brain

Polygonal clear cells

Renal Cell Carcinoma

What is the classic triad of Renal Cell Carcinoma?

1. Hematuria (50%)
2. Flank pain
3. Palpable mass

Patient presents with cola-colored urine and flank pain. After taking a careful history you find that the man has low-grade fever & has lost 10 lbs over the past month. He is a chronic smoker. On physical exam you feel a large mass in the left kidney. Lab demonstrates Secondary Polycythemia

Renal Cell Carcinoma

What is the 5-year survival for Renal Cell Carcinoma?

40%

What paraneoplastic syndromes are associated with Renal Cell Carcionoma?

Acute Tubular Necrosis
-Proximal Convoluted Tubules are thin walled when they should be Tall columnar

What is this?

Acute Tubular Necrosis
-epithelium of the tubules seen here are rugged from undergoing necrosis from Ischemia
-Heart failure with hypotension precipitated the ATN

What is this pic showing?

Acute Tubular Necrosis
-The tubular vacuolization and tubular dilation here is a result of the toxic effect of ethylene glycol poisoning. This is representative of acute tubular necrosis (ATN), which has many causes. ATN resulting from toxins usually has diffuse tubular involvement, whereas ATN resulting from ischemia (as in profound hypotension from cardiac failure) has patchy tubular involvement.

What is seen here?

Acute Pyelonephritis

-This is a gross photograph of a kidney showing scattered grey-white areas representing collections of acute inflammatory cells. The pelvis is dilated, which is consistent with hydronephrosis. The most common pathogen associated with acute pyelonephritis is E. coli. Acute PN is secondary to an ascending infection usually beginning in the bladder. Vesicoureteral reflux is the most common cause of acute pyelonephritis.

Oncocytoma
-benign tumor that has a pink cytoplasm and small nucleus
-cytoplasm has abundant mitochondria

What tumor is this?

Angiomyolipoma

What renal tumor is this?

Angiomyolipoma
-Blood vessels
-Smooth Muscle
-Fat

Tubular Sclerosis Syndrome

What is shown here?

What is it associated with?

Angiomyolipoma

-This is the low power microscopic appearance of an angiomylolipoma. There is normal renal parenchyma at the left. The tumor has a strip of adipose tissue (the "lipoma" part) that then blends in with interlacing bundles of smooth muscle (the "myo" component) in which are scattered vascular spaces (the "angio" component).